title: Beating-heart coronary artery bypass grafting using a miniaturized extracorporeal circulation system.
abstract: BACKGROUND
  Experience with miniaturized coronary artery bypass (CAB) systems in coronary artery bypass graft (CABG) surgery on the beating heart is limited. We used a relatively new miniaturized cardiopulmonary bypass (CPB) system, which we termed assisted CAB (ACAB), to perform CABG on the beating heart in 110 patients, and we analyzed clinical outcomes in this patient group.
  
  
  METHODS
  Between January 2004 and September 2006, we used ACAB to perform CABG on the beating heart in 110 patients. The mean patient age was 73 +/- 8.1 years. The ACAB system uses a small prime volume of only 500 mL, and the circuit is shorter than that used in conventional CPB. In addition, the tubing and oxygenator systems were surface-coated with phosphorylcholine. The initial heparin dose was 150 IU/kg, with a target activated clotting time of >250 seconds. With this management, none of the patients experienced system thrombosis. We did not use cardioplegia or aortic crossclamping and did not routinely retransfuse cardiotomy blood. Observational data for the 110 patients were analyzed.
  
  
  RESULTS
  The mean number of anastomoses performed was 2.67. The rate of perioperative infarction was 1.8% (2 patients). Perioperative mortality was 7% (8 patients). The mean EuroSCORE for all patients was 6.4 +/- 4, whereas it was 13.75 +/- 6.18 for the patients who died. Mean CPB time was 64.96 +/- 16.66 minutes.
  
  
  CONCLUSIONS
  In our experience, beating heart CABG supported by a miniaturized CPB is a safe procedure with acceptable perioperative results.
authors.affiliation: Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Ruhr-University Hospital, Bochum, Germany. delawer.reber@ruhr-uni-bochum.de
authors.forename: Delawer
authors.initials: D
authors.lastname: Reber
authors.forename: Markus
authors.initials: M
authors.lastname: Fritz
authors.forename: Paschalis
authors.initials: P
authors.lastname: Tossios
authors.forename: Dirk
authors.initials: D
authors.lastname: Buchwald
authors.forename: Michael
authors.initials: M
authors.lastname: Lindstaedt
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Klak
authors.forename: Peter
authors.initials: P
authors.lastname: Marks
authors.forename: Axel
authors.initials: A
authors.lastname: Laczkovics
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008904:Miniaturization; D009203:Myocardial Infarction / Q000209:etiology*; D016896:Treatment Outcome